Provider Demographics
NPI:1003255639
Name:BADILLO, NICOLE ANN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:BADILLO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:FERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:5400 GIBSON BLVD. SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108
Mailing Address - Country:US
Mailing Address - Phone:505-262-7000
Mailing Address - Fax:505-262-7729
Practice Address - Street 1:4010 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-254-6500
Practice Address - Fax:505-254-6540
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92532364SW0102X
NMCNP02787363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health